Individual
GOLNESA ROUIE MIAB
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2048 1ST CAPITOL DR, SAINT CHARLES, MO 63301-1647
(314) 498-8093
Mailing address
112 OLD OAKS DR, BALLWIN, MO 63011-2705
(314) 498-8093
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019033266
IL
1223G0001X
General Practice Dentistry
2021028071
MO
Other
Enumeration date
06/28/2021
Last updated
11/07/2021
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